以胰腺炎为首发症状的二次铊中毒1例

Pancreatitis as first symptom in patients with secondary thallium poisoning: A case report and literature review

目的报告1例二次铊中毒的临床特点及诊治。方法解放军总医院2015年2月29日收治1例铊中毒女性患者,42岁,以腹痛、血淀粉酶、脂肪酶升高为首发症状,按照"急性胰腺炎"治疗好转。1个月后出现突发性精神行为异常及重症吉兰-巴雷综合征样临床表现,血液及尿液中铊浓度明显升高,诊断为铊中毒,结合病史及相关文献,推测患者经历2次铊中毒,既往未见此类报道。结果尿检证实铊中毒,经积极治疗后恢复较好。结论若神经系统症状、腹部症状及脱发同时或相继出现,应警惕铊中毒。

Objective To report the clinical features, diagnosis, management and evaluation of the outcome of a patient with secondary thallium poisoning. Methods The patient was a 42-year-old female who had experienced abdominal pain with elevated blood amylase and lipase as the first symptom. She was diagnosed with acute pancreatitis in the local hospital and the symptoms relieved after treatment. One month later, she developed abnormal mental behavior rapidly and severe Guillain-Barre syndrome turned up gradually. Thallium concentration significantly elevated in the blood and urine, which led to the diagnosis of Thallium poisoning. After reviewing of retrospective clinical history of this case and related literature, we suspected that she experienced thallium poisoning for the second time. So far as we know, this was the first report about people experienced thallium poisoning two times in one month. Results This case was confirmed by urinalysis, and the symptom of patient improved slowly after active treatment. Conclusion When a person experiences alopecia, peripheral neuropathy and gastrointestinal disorders in a short time, it is reasonable to consider the possibility of thallium poisoning.